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Obs/Gynae > Puberty and Menopause > Flashcards

Puberty and Menopause Flashcards

1
Q

What is puberty?

A

Process of reproductive and sexual development and maturation that which changes a child into an adult

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2
Q

At what age does Puberty start?

A

Begins between ages 8 to 13

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3
Q

What two physiological processes influence puberty?

A

Gonadarche and Adrenarche

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4
Q

What activates GnRH?

A
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5
Q

Describe Gonadarche

A

Activation of the gonads by the pituitary gland hormones( follicle stimulating and luteinizing hormone

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6
Q

At what age do secretions for GnRH start? And to what frequency are the secreted?

A

From the age of 8 to 9, GnRH is secreted in pulsations of increasing amplitude and frequency

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7
Q

Explain the process of Adrenarche?

A

Zona reticularis of the adrenal glands begins to secrete dehydroepindrosterone (DHEA) and androsterone
Results in androgenic changes i.e growth of pubic and axillary hairs, maturation of apocrine sweat glands

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8
Q

When does adrenarche begin?

A

About years before true puberty.

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9
Q

Describe the sequence of pubertal maturation?

A

Growth Spurt
Thelarche
Pubarche
Peak Growth Velocity
Menarche

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10
Q

What is Thelarche and when does it first occur? What causes it?

A

-Breast development due to action of estradiol
-2-3 years before menarche

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11
Q

What is Pubarche and when does it occur and what is it dependent on?

A

-Appearance of first pubic hair and axillary hair
-Usually after thelarche and dependent on adrenal androgens

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12
Q

What is Pubarche usually associated with?

A

-Development of acne and apocrine body odor

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13
Q

What is and causes the growth Spurt?

A
  • Accelerated increase in height
    -Due to the effect of growth hormones and estrogen
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14
Q

When does the growth Spurt usually occur?
How does it differ between girls and boys?

A

-Begins around 11years and mostly ceases by 15years
-Earlier in girls than in boys

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15
Q

What is key feature of the first menstrual bleeding?

A

The first menstrual bleeding is most of the times not influenced by ovulation but rather the effects of estrogen on the endometrial lining. May take over 2-3 years before the menstrual cycle establishes a regular pattern due to immaturity of the HPG axis. Initial cycles are anovulatory and can be unpredictable and irregular

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16
Q

Describe Tanner’s Staging of breast and pubic hair development?

A

REFER TO HANDOUT

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17
Q

What factors influence the onset of puberty?(5)

A

Genetics
Race
Body weight
Social environment
Overall health

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18
Q

What issues arise with puberty?

A

Psychological issues like depression
Anemia
Acne
Gynecological conditions
Musculoskeletal injuries
Sexually transmitted infections

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19
Q

What are the two categories of puberty?

A

1.Precocious
2.Delayed

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20
Q

What are the two types of precocious Puberty?

A

1.Central-Gonadotropin dependent
Aetiology is unknown but 25% due to CNS malformation or brain tumours

2.Peripheral -gonadotropin independent
Caused by oestrogen secretion such as exogenous ingestion or a hormone-producing tumour

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21
Q

What are the causes of central precocious puberty? And what is the most common cause?

A

most common cause is idiopathic
CNS lesions (gliomas, craniopharyngiomas)
Genetics
Pituitary gonadotropin-secreting tumors
CNS infections (meningitis)
Head trauma
CNS anomaly (hydrocephalus)
Iatrogenic (radiation, chemotherapy)

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22
Q

What is the typical presentation of someone with central precocious puberty? And why?

A

-Taller than peers during adolescence but shorter by adulthood
Due to early epiphyseal closure

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23
Q

What investigations are done in central precocious puberty?

A

FSH and LH (mainly LH): elevated
GnRh stimulation test (gold standard)
High GnRH High FSH and LH
Serum oestrogen (elevated)
Imaging
X-ray of hand, left wrist: allows comparison between skeletal maturation and chronological age

24
Q

What is the management for central precocious puberty?

A

-GnRH agonist e.g goserelin
-Manage underlying cause

25
Q

Why is an X-ray of the hand or wrist done?

A

To explain bone age, as children develop,their bones change in size and shape. These changes can be seen radiographically and can be correlated with chronologic age.
Thus, the radiographic “bone age” is the average age at which children in general reach a particular stage of bone maturation.
Girls with early estrogen excess from precocious puberty show growth-rate acceleration, rapid bone-age advancement, and early epiphyseal closure, which leads to short stature

26
Q

What are the causes of Peripheral precocious puberty?

A

Oestrogen or testosterone producing tumours
Adrenal or ovarian (granulosa cell tumor most common)
Other causes include
Ovarian cysts
Ovarian tumours
Primary hypothyroidism
Exogenous androgen or oestrogen exposure
McCune-Albright syndrome

27
Q

What is the triad for McCune Albright Syndrome?

A

-polyostotic fibrous dysplasia, -irregular caf~-au-lait spots
-Endocrinopathies.

28
Q

What investigations are done in Peripheral precocious puberty?

A

Pelvic sonography
Measuring serum hormonal levels to check the levels of FSH, LH and estrogen
Thyroid function test

29
Q

What is the management for peripheral precocious puberty?

A

Gonadotropin releasing hormone analogue therapy like leuprolide acetate or triptorelin

30
Q

What is delayed puberty?

A

-When no signs of secondary sexual characteristics by the age of 13 years.
-In girls, considered delayed when there is no breast development by age 13
-Also considered delay if menses have not commenced by age 15 or within 3 years of thelarche

31
Q

What are the types of delayed puberty? Which of them is the most common?

A

-Hypergonadotrophic hypogonadism
-Hypogonadotrophic Hypogonadism
-Constitutional Delay(Most common)

32
Q

What are the characteristics of constitutional delay?

A

-Adolescents lack both secondary sexual characteristics and pubertal growth spurt by age 13 years

33
Q

What is the cause of Constitutional delay?

A

The probable cause is a delay in reactivation of the GnRH pulse generator

34
Q

What are the causes of Hypogonadotrophic Hypogonadism?

A

Abnormalities of the hypothalamus or pituitary gland e.g Kallman syndrome
Causes include use of steroids, hyperprolactinemia, chronic illness, malnutrition , anorexia nervosa, severe pituitary gland infections, injury or tumors

35
Q

What is Kallmans Syndrome?

A

-Genetic disorder characterized by delayed puberty and anosmia. caused by underdevelopment of specific special neuron responsible for signals the hypothalamus to produce the gonadotropin releasing hormones. Since the hypothalamus and the olfactory system develop from the same cells the patient also presents with anosmia

36
Q

What are the causes of hypergonadotropic hypogonadism?

A

Abnormalities in the ovaries resulting in little or no production of estrogen
Turners syndrome( ovarian dysgenesis)
Androgen insensitivity syndrome
Chemotherapy and radiations
Infections such as mumps
Premature ovarian failure (POF) can occur and can be:
Idiopathic
Part of autoimmune disorder
Following chemo or radiotherapy for childhood cance

37
Q

What is the management of delayed puberty?

A

reat the underlying cause
Hormonal therapy
Low dose of estrogen and monitor developmental changes
Add progesterone to start menstruation
Oral contraceptive pills to maintain normal levels of sex hormones

38
Q

Define menopause?

A

Menopause refers to a point in time that follows 1 year after the complete cessation of menstruation

39
Q

Define Perimenopause

A

The period beginning with the first clinical biological and endocrinological features of approaching menopause and ends 12 months after the EMP.

40
Q

Define Premenopause ?

A

Period prior to menopause

41
Q

Define climasteric ?

A

Period of time during which a woman passes through the reproductive to the non reproductive stage. Covers 5-10 years of menoapuse.

42
Q

Define menopausal transition?

A

the period between onset of irregular menstrual cycle and the last menstrual cycle. Begins between ages 45 to 55
Average age of women experiencing their final menstrual period (FMP) is 51.5 years, but a halt to menses from ovarian failure may occur at any age.

43
Q

Define premature menopause?

A

-Spontaneous menopause occurring 2 SD below the mean estimated age for the reference population.
-Permanent cessation of menses before the age of 40

44
Q

Describe induced menopause?

A

cessation of menstruation following bilateral oophorectomy or iatrogenic ablation of ovarian function.

45
Q

What are the signs and symptoms of menopausal transition.

A

Menstrual pattern
Shorter cycles (typical)
Longer cycles (possible)
Irregular bleeding

Vasomotor
Hot flashes
Night sweats
Sleep disturbances

Psychological/cognitive
Worsening PMS
Depression
Irritability
Mood swings
Poor concentration
Poor memory

Sexual dysfunction
Vaginal dryness
Decreased libido
Dyspareunia

Somatic
Headache
Dizziness
Palpitations
Joint aches and back pain

Others
Urinary incontinence
Dry, itchy skin
Weight gain
Osteoporosis

46
Q

Define Premature menopause ?

A

Idiopathic
Surgery –removal of the ovaries, total hysterectomy
Ovarian insufficiency –failure of adequate ovarian function
Causes ; idiopathic
Genetic disorders like turners syndrome, fragile X
Iatrogenic causes like chemotherapy and radiations
Toxins: smoking

46
Q

Describe the physiology of menopause?

A

Numerical depletion of oocyte resulting in low estrogen production
Negative feedback to the hypothalamus lost
Increased production of FSH and LH by the pituitary gland
High levels of FSH results into desensitization of the FSH receptors in the ovarian follicles
Eventually, no or less production of estrogen hence menopause

46
Q

What are the effects of estrogen deficiency?

A

Bones
Reduced bone density which results into osteoporosis
Cardiovascular system
Increased risk of atherosclerosis – increased risk of coronary artery disease
Urinary tract
Atrophy of the urinary tract system resulting into increased risk of urinary tract infections, urine incontinence, dysuria, urgency and frequency

47
Q

How is menopause diagnosed?

A

1.Diagnosis is largely clinical
Cessation of menstruation for consecutive 12 months
2.Appearance of menopausal symptoms eg hot flushes and night sweats
3.Serum estradiol < 20pg/ml
4.Serum FSH and LH > 40mIU/ml

48
Q

What is the management of menopause?

A

Non hormonal
Life style modification
Diet
Exercise
Sleep hygiene
Hormonal
Hormonal replacement therapy

49
Q

How does menopausal HRT work?

A

Restores premenopausal physiological state hence relieving symptoms of menopause

50
Q

What drugs are used for Menopause HRT? And what is their MOA?

A

1.Tibolone : inhibits bone resorption by reducing osteoclastic activity, improves VMS and urogenital atrophy, improve libido
2.Selective estrogen receptor modulators(SERMs): eg raloxifene and tamoxifen treats osteoporosis

51
Q

What are the indications of HRT?

A

Depression
Joint aches and pain
Hot flushes
Vulvovaginal atrophy

52
Q

What are the contraindications of HRT?

A

History of breast cancer, ovarian cancer and uterine cancer
History of chronic heart failure
Liver disease
Pregnancy
Thromboembolic events

53
Q

What are the side effects of HRT?

A

Venous thromboembolism
Pulmonary embolism
Thrombogenic stroke
Coronary heart disease
Breast and endometrial cancer
Vaginal bleeding

Obs/Gynae (16 decks)

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